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Transcript of Metrics That Matter - colemanpalliative.uchicago.edu · intensive care unit 4.8 times more likely...
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Metrics That Matter
1
26 February 2016
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Session Objectives
At the end of this session, you will be able to
1. Identify core metrics to benchmark the performance of a palliative medicine program
2. Enter data in formats that facilitate rapid analysis
3. Identify organizational support staff who can provide access to relevant data
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The National Environment for Palliative Care Teams
• 4.4% of patients admitted to an acute care hospital in the US had a palliative medicine consultation in 2014 (range 0.3%-16.8%)
• In 2012, 3.6% of patients had palliative medicine consultations
• Source National Palliative Care Registry sample of ~10% of US hospitals
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Palliative Care Registry and Outcomes Evaluation
Aim: To provide metrics on palliative care program characteristics and outcomes across fellowship sites to improve patient care and costs
1. Palliative Care Registry – Study of characteristics of palliative care programs at all participating
sites
– Administered in 2015 for program information, 2012 – 2014
2. Outcomes Study – COMPData: Hospital inpatient billing information for patients
discharged to hospice or died in-hospital
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Types of Services offered by Palliative Care Services for Responding Institutions to the Registry (N=23)
• 74% have an inpatient consultation service
• 52% have outpatient clinics
• 43% have home palliative care programs
• 22% have services in skilled nursing facilities
• 9% have an inpatient palliative care unit
• 9% have inpatient hospice units
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Staffing Models: 2012 and 2014, N = 12
Provider 2012 FTEs
Median (25 – 75%) 2014 FTEs
Median (25 – 75 %)
Physician 0.9 (0 – 2.3) 1.1 (0.2 – 2.7)
Advanced nurse practitioner
1.0 (0.8 – 1.0) 1.0 (0.8 – 2.0)
Social worker 0.3 (0 – 0.5) 0.4 (0.1 – 1.0)
Chaplain 0 (0 – 0.5) 0 (0 – 0.5)
Other 0.2 (0 – 1.0) 0.2 (0 – 1.3)
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Proportion of Hospitals with Each Provider Type in the Palliative Care Program (N = 11)
83% 83%
75%
42%
92%
75%
Physician Advanced nursepractitioner
Social worker Chaplain At least 2 typesof providers
At least 3 typesof providers
--Interprofessional Teams--
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Discharges to Hospice by Team Composition % of hospital discharges to hospice versus in-hospital death
2011 2012 2013 2014With SW and APN both on team (n = 16,349)
Without SW or APN on team (n = 10,830)
0%
10%
20%
30%
40%
50%
2011 2012 2013 2014With social worker on team (n = 17,353)
Without social worker on team (n =8,460)
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Palliative Care Consults as a Percent of Total Discharges
Beauchamp TL. Principles of Biomedical Ethics, 5th ed. Oxford Univ Press 2001.
4.4%
8.0%
National Coleman Fellowship Hospitals
N = 9 hospitals reporting the number of palliative care consultations for 2014
Within the Coleman Fellowship Hospitals
Range: 1.0% - 24.4%
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Patients with a palliative care consultation were…
45% less likely to have any care in the
intensive care unit
4.8 times more likely to be discharged
to hospice
For patients discharged to hospice or who died in-hospital at Rush University Medical Center
Discharge dates: Oct 2011 – Sep 2012; Oct 2013 – Sep 2014
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Hosp A Hosp B Hosp C Hosp D Hosp E Hosp F
Inpatient Palliative Care Service Utilization at Local Academic Medical Centers in Fiscal Year 2014
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Outpatient Palliative Care Service Utilization at Local Academic Medical Centers in Fiscal Year 2014
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Funding of Palliative Medicine Teams in the Chicagoland Area (FY-14)
• The mean support from professional revenue 34.5% (range 0 to 100% of the cost of supporting a team)
• Six programs had 100% support from their hospital hospital (range 0 to 100%), and mean support is 63.9%
• The support from hospice range is 0-50%, and mean support is 12%
• Philanthropy supported an average of 16.5% of operational support (range 0% to 100%)
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Metrics That Matter: Some Key Metrics
14
• Number of inpatient consultations
• Number of outpatient consultations
• Full-time equivalent staff by role
• Discharges to hospice versus in-hospital death
– Length of hospital stay
– Intensive care unit use
– Reason for admission
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And From These Metrics…
15
• Ratio of inpatient consultations to outpatient consultations
• Inpatient consultations per palliative care team FTE
• Outpatient consultations per palliative care team FTE
• Length of hospital stay for patients discharged to hospice versus in-hospital death
• Number of ICU days for patients discharged to hospice versus in-hospital death
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Palliative Care Consults and End of Life Outcomes, 2013 - 2014, Rush University Medical Center
97
332
280
160
Hospice In-Hospital Death Hospice In-Hospital Death
Without Palliative Care Consult With Palliative Care Consult
23% discharged to hospice
64% discharged to hospice
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Tips on Collecting Data
17
• Think about how the data should be organized and what you want to accomplish
• Use a spreadsheet
• Create a data dictionary
• Use consistent coding
• Pilot data collection with a few records
• Review pilot data and plan for how you will use it
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Example
18
Patient Identifier Consultation Date Reason for Consultation Provider
ABCD Jan 1, 2016 Don't know T. Johnson
EFGH 1/2/2016 cancer SPM
IJKL Jan-05-16 cancer, lung Johnson, T.
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Example
19
Patient Identifier Consultation Date Reason for Consultation Provider
ABCD 01/01/2016 99 021
EFGH 01/02/2016 1 022
IJKL 01/05/2016 1 021
Provider Look-up Table
021 Johnson, Tricia
022 Miller, John
023 Jones, Mary
Reason Look-up Table
1 Cancer
2 Stroke
3
…
99 Unknown
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Key Organization Support Areas
20
• Quality: Performance metrics, outcomes, benchmarking data
• Finance: Cost per admission, billing information
• Information services: Electronic medical record information; billing information